Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Front Cell Infect Microbiol. 2023 May 31;13:1206111. doi: 10.3389/fcimb.2023.1206111. eCollection 2023.
Glioblastoma (GBM) is one of the most lethal cancers, having a poor prognosis and a median survival of only about 15 months with standard treatment (surgery, radiation, and chemotherapy), which has not been significantly extended in decades. GBM demonstrates remarkable cellular heterogeneity, with glioblastoma stem-like cells (GSCs) at the apex. GSCs are a subpopulation of GBM cells that possess the ability to self-renew, differentiate, initiate tumor formation, and manipulate the tumor microenvironment (TME). GSCs are no longer considered a static population of cells with specific markers but are quite flexible phenotypically and in driving tumor heterogeneity and therapeutic resistance. In light of these features, they are a critical target for successful GBM therapy. Oncolytic viruses, in particular oncolytic herpes simplex viruses (oHSVs), have many attributes for therapy and are promising agents to target GSCs. oHSVs are genetically-engineered to selectively replicate in and kill cancer cells, including GSCs, but not normal cells. Moreover, oHSV can induce anti-tumor immune responses and synergize with other therapies, such as chemotherapy, DNA repair inhibitors, and immune checkpoint inhibitors, to potentiate treatment effects and reduce GSC populations that are partly responsible for chemo- and radio-resistance. Herein, we present an overview of GSCs, activity of different oHSVs, clinical trial results, and combination strategies to enhance efficacy, including therapeutic arming of oHSV. Throughout, the therapeutic focus will be on GSCs and studies specifically targeting these cells. Recent clinical trials and approval of oHSV G47Δ in Japan for patients with recurrent glioma demonstrate the efficacy and promise of oHSV therapy.
胶质母细胞瘤(GBM)是最致命的癌症之一,预后不良,采用标准治疗(手术、放疗和化疗)的中位生存期仅约 15 个月,几十年来没有显著延长。GBM 表现出显著的细胞异质性,以胶质母细胞瘤干细胞(GSCs)为顶点。GSCs 是 GBM 细胞的一个亚群,具有自我更新、分化、启动肿瘤形成和操纵肿瘤微环境(TME)的能力。GSCs 不再被认为是具有特定标志物的静态细胞群体,而是在驱动肿瘤异质性和治疗耐药性方面表现出相当大的表型灵活性。鉴于这些特征,它们是成功治疗 GBM 的关键靶标。溶瘤病毒,特别是溶瘤单纯疱疹病毒(oHSV),具有许多治疗属性,是靶向 GSCs 的有前途的药物。oHSV 经过基因工程改造,能够选择性地在癌细胞(包括 GSCs)中复制并杀死这些细胞,但不会杀死正常细胞。此外,oHSV 可以诱导抗肿瘤免疫反应,并与其他疗法(如化疗、DNA 修复抑制剂和免疫检查点抑制剂)协同作用,增强治疗效果并减少部分导致化疗和放疗耐药的 GSC 群体。本文综述了 GSCs、不同 oHSV 的活性、临床试验结果以及增强疗效的联合策略,包括 oHSV 的治疗武装。全文的治疗重点将是 GSCs 以及专门针对这些细胞的研究。最近的临床试验和 oHSV G47Δ 在日本获得复发性脑胶质瘤患者的批准证明了 oHSV 治疗的疗效和前景。
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